Organization
JAMESTOWN CONDOTTIERE IMPLANT&GENERAL DENTISTRY CTR. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALDOUS WILSON (OWNER)
(404) 767-9356
Entity
Organization
Contact information
Practice address
2457 RIVERDALE RD, ATLANTA, GA 30337-5003
(404) 767-9356
(404) 529-4465
Mailing address
2457 RIVERDALE RD, ATLANTA, GA 30350
(404) 767-9356
(404) 529-4465
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DNO11947
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00809025B
—
GA
Enumeration date
04/07/2008
Last updated
04/07/2008
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